血清蛋白B亚型和神经元特异性烯醇化酶对早期判断体外循环术后脑损伤的意义

Clinical values of detection of serum levels of SIOOB and NSE in diagnosis of brain injuries at early period after cardiopulmonary bypass

目的探讨血清 S100蛋白 B 亚型(S100B)和神经元特异性烯醇化酶(NSE)水平对早期判断体外循环手术后脑损伤的应用价值。方法心脏病手术患者48例,体外循环组(n=40)和非体外循环组(n=8),于手术前、后24 h 和48 h 检测血清 S100B 和 NSE 的浓度,术后48 h 根据"心脏术后神经功能状况评估法"计算脑损伤指数(DQ)。结果在体外循环术后24 h 和48 h 血清 S100B(0.61μg/L±0.18μg/L,0.37μg/L±0.12μg/L)和 NSE(10.14μg/L±3.87μg/L,5.77μg/L±2.31μg/L)的浓度均高于术前水平(0.05±0.03μg/L,2.98±1.49μg/L)(均 P<0.01),而非体外循环组术后 S100B(0.05μg/L±0.03μg/L,0.04μg/L±0.03μg/L)和 NSE(2.91μg/L±1.56μg/L,2.87μg/L±1.41μg/L)与术前浓度(0.04μg/L±0.03μg/L,2.76μg/L±1.23μg/L)无差异(均 P>0.05)。体外循环术后24 h 和血清 S100B 和 NSE 的水平与年龄、体外循环时间及主动脉阻断时间相关(均 P<0.05)。血清 S100B 和 NSE 的水平与 DQ 均呈正相关(r=0.739 P<0.01,r=0.371 P<0.05)。结论血清 S100B 和 NSE 均为判断体外循环术后脑损伤的特异性指标,但联合检测血清S100B 和 NSE 的特异性最高。

Objective To investigate the clinical values of detecting the blood serum levels of S100B and neuron-specific enolase （NSE） in diagnosis of brain injuries at early period after cardiopulmonary bypass （CPB）. Methods Forty-eight patients with heart disease were divided into 2 groups： CPB group （n = 40） and off-CPB group （n = 8 ）. Before operation, and 24 hours and 48 hours after CPB specimens of peripheral blood were collected and ELISA was used to detect the serum levels of S100B and NSE. Forty-eight hours after the operation brain damage quotient （DQ） was calculated. Results The serum levels of S100B 24 and 48 hours after operation of the CPB group were 0.61 μg/L±0.18 μg/L and 0.37 μg/L ±0. 12 μg/L respectively, both significantly higher than that before the operation （0,05 μg/L ±0.03 μg/L, P 〈0. 001 ）. The serum levels of NSE 24 and 48 hours after operation of the CPB group were 10.14 μg/L ± 3.87 μg/L and 5.77μg/L± 2.31 μg/L respectively, both significantly higher than that before operation （2.98 μg/L ± 1.49 μg/L, P 〈 0.001 ）. The serum levels of S100B 24 and 48 hours after operation of the off-CPB group were 0. 05 μg/L ± 0. 03 μg/L and 0. 04 μg/L ± 0. 03 μg/L respectively, both not significantly different from that before operation （0.04 μg/L ± 0.03 μg/L, P 〉 0.05 ）. The serum levels of NSE 24 and 48 hours after operation of the off-CPB group were 2.91 μg/L ± 1.56 μg/L and 2. 87 μg/L ± 1.41 μg/L respectively, both not significantly different from that before operation （2.76 μg/L ± 1.23 μg/L , P 〉0.05）. The levels of S100B and NSE 24 hours after CPB were positively correlated with age, CPB time, and cross-clamp time （all P 〈 0. 05 ）. The levels of S100B and NSE 48 hours after CPB were positively correlated with the brain DQ （r = 0.739 P 〈 0.01, r = 0.371 P 〈 0.05 ）. The multiple correlation coefficient square （R^2 ） of detection of the levels of both S100B and NSE was 0. 851, significantly higher than that of mere detection of S100B （R2 = 0. 703 ） and that of mere detection of NSE （R^2 = 0.482） （both P 〈0.01 ）. Conclusion Both serum S100B and serum NSE are sensitive markers in the early diagnosis of brain injuries after CPB. Detection of both S100B and NSE is the most specific, and mere detection of S100B comes behind.